City of Peoria
Sustainability & Water Conservation
Water Conservation Kit
Limit one per water account
Water Billing Account Number (XXXXX-X)
*
Name
*
First Name
Last Name
Address
*
Street Address
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Preferred Library Pickup Location
*
Peoria Public Library (8463 W Monroe St, Peoria, AZ 85345)
Sunrise Mountain Library (21109 N 98th Ave, Peoria, AZ 85382)
Have you previously participated in a City of Peoria Sustainability & Water Conservation Program?
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Yes
No
How would you describe your current level of familiarity with water conservation practices?
*
Extremely Familiar
Moderately Familiar
Somewhat Familiar
Slightly Familiar
Not At All Familiar
How did you first hear about this program?
Please Select
Bill Insert (PeoriaNOW)
City Building (Library, etc.)
City Employee
City Event
City Mail (Sustain & Gain, etc.)
City Website
Email/Newsletter
Family/Friends/Neighbor
HOA/Community Org
Internet Search
Landscaper/Contractor
News Outlet
Peoria School
Social Media
Store/Business
Choose the option that fits best.
I commit to installing the water efficient devices within a month of pickup.
*
PLEDGE TO SAVE WATER
Submit
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